Old age ain’t for sissies: Bette Davis
This is one of my mother’s favourite sayings. I just thought I’d be a little older than 61 before it became my catch cry! And before everyone flicks over to the next story on Facebook or Twitter to avoid the gross thought of a blog on my own (PF) pelvic floor- this article is on the other PF, the other disruptor in my life, which has reared its ugly head again, seven years after I first encountered it.
In 2009, when holidaying at Noosa, we walked furiously up and down Noosa beach – in those days barefoot, pounding away trying to keep fit and soaking up the vista of the rolling waves and picture perfect scenery. It wasn’t the happiest of holidays as my father was very ill and I was driving up and down to Brisbane to see him in hospital. Each day as I kept walking there was a peculiar, unpleasant tenderness under my right heel. It was weirdly sorer after I had rested and then when tried to weight bear as I got up from the lounge or the beach, I had a nasty limp which quickly passed and I wondered what the hell was wrong – I am after all a PF (vagina-centric pelvic floor) physio.
We returned to Brisbane after the two-week holiday and then visited my increasingly unwell father daily at the Wesley, walking up and down the steep hills around the hospital in a rather pretty pair of crystal adorned sandals, with a rock hard leather sole. During this time I could barely weight bear on my right foot – the pain was intensive and unrelenting, but there were much bigger and ultimately sadder events unfolding. Dad passed away at the end of January, so there was immense grief and of course plenty of stress and anxiety. Over the course of the next few months, as we sorted Dad’s affairs, my foot got worse and worse – and eventually the diagnosis was made – I had Plantar Fasciitis, one of the most common causes of heel pain.
It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain, that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting. (1)
It was and still is amazing, how many women (and men) suffer with my affliction. It became a talking point with me and my patients, swapping stories, remedies, stretches, brands of shoes, inner soles, orthotics, spikey Massuse shoes – they all had their own success and many failure stories. At first I was wearing joggers to work; then I started to frequent orthopaedic shoe shops to try on shoes I thought I was going to be wearing in my 90’s not my 50’s; next came the moon boot; and then had a stint on crutches. It was quite depressing to even get up and get a drink of water because when you have plantar fasciitis, the worst pain is after you have been resting off it.
About two weeks after the diagnosis in 2010, I contemplated a steroid injection, but then came the horror stories of failed injections, of the excruciating pain of the injection and of feet made worse. So I decided against it and endured a foot hell for about 9 months until a radiologist friend at a party asked me why I was walking with such a limp? When he heard, he sort of ordered me to attend his rooms pronto, for an ultrasound-guided cortisone injection. So I did that on the next available appointment and I walked in on crutches and walked out carrying them under my arm!
There was the odd day of soreness but really after 9 months of excruciating pain – it just vaporised. The next time I felt it twinge/burn/talk to me was 12 months later at my first ‘Explain Pain’ course and Dave Butler called Plantar Fasciitis a chronic pain condition. My sore right heel, which had not been sore for about a year started to burn – I wanted him to shut up, I wanted to run out of the room, I was in a momentary world of fear, and cortisol and adrenaline were rushing through my body. A classic reaction which taught me in a second about the brain and its primitive approach to chronic pain.
As a result of this experience with plantar fasciitis, I had changed my behaviours with shoe-buying for a number of years – never anything with hard leather inner soles, not too flat and I was always having to test them for days/ weeks on carpet before I was game to wear them out in the real world. I found a great pair of joggers and then bought 3 pairs of the same shoe and have worn them all out with kilometres of pain-free walking for all these years………until March 2017.
On this particular weekend, I had spent a weekend walking barefoot around the house on our wooden floors, something I never usually did since my first painful heel experience and then really ‘strode it out’ on a couple of walks around the neighbourhood in a frantic attempt to ‘get fit urgently’ to hike Mont Blanc this year in September.
Walking trails Mont Blanc – the goal.
Suddenly there it was again – intense heel pain- this time in my left heel. I was shocked. And then I started to panic. ‘This is not good’ my deep primitive brain started saying out loud. My brain flashed back to the last time this happened, when I was incapacitated for 9 months, when I wore very ugly shoes and I couldn’t walk as my form of exercise.
Since that realisation that plantar fasciitis was back in the frame, I have frantically embarked on the roundabout of ALL of the plantar fasciitis treatments to get rid of my pain. You can click on this great systematic review of evidence for all the treatments for PF (plantar fasciitis) and since my heel pain has started, our PF (pelvic floor) physiotherapy practice has become PF (plantar fasciitis) obsessed and we are having staff meetings and inservices to brainstorm my foot.
I have been furiously icing, stretching, massaging, strengthening the intrinsic muscles, relaxing all the muscles, strapping, taking anti-inflammatories, taking 10mg Endep, doing neurodynamic stretches and applying chronic pain science principles to my foot pain – and that was by the end of the first week. I have even tried prednisone for a week (did nothing but give my already hearty appetite a boost) and have even contemplated a short burst of oral HRT (hormone replacement therapy -as one of the theories mooted is that as women age and become menopausal, their tendons thin, as does the heel fat pad, and hence more pressure and strain on the plantar fascia). But I decided against that.
What I do have now is an impressive array of joggers that I have bought in the attempt to find a shoe that allows me to walk and not think every second- yes, there’s my left heel, oh damn now there’s my right heel – a classic example of too much talk coming from my feet, through the dorsal root ganglion of the spinal cord and shooting up to the representation of my feet on the sensory brain map. Hopefully one day I will be able to wear my joggers and STOP thinking about my feet.
Strassburg foot sock (This stacked up pretty well in the evidence)
I was living the nightmare of my pain patients – I was anxious; catastrophising; panicking; trying multiple treatments all at once; and watching my dream of hiking hundreds of kilometres around Mont Blanc disintegrate into pieces.
Not too long into the process, I decided to head straight to the ultrasound-guided cortisone injection, after all, that saved the day 7 years ago. Dr Steve, who did my first miraculous injection was away on holidays (damn him) when I made the appointment, but I couldn’t wait the 3 weeks for him to come back, so headed in for my jab. Sadly, it didn’t work and if you read the articles, unfortunately that is the case, not all steroid injections work.
After 8 weeks of pain, I decided to consult a specially designated Heel Pain Clinic. $720 and 25 minutes later the impressions of my feet for special plantar fasciitis orthotics were on their way to Sydney to be manufactured and they were going to save the day…. in 4 weeks time. These are designed to tilt my calcaneus (heel bone) laterally, to relieve the pressure on the plantar fascia. They arrived by Express post a week later and were popped into my shoes to await a miracle cure.
Day after day I woke up thinking “IS it better? IS there a change?”
I think the change from the orthotics was minuscule and after giving them a go for 5 solid weeks, it was time for a last-ditch effort – another steroid injection. Dr Steve was available and while his conversation with me just prior to the injection – ‘that I was the first and last person that had ever had such a fantastic, miraculous, complete cure in 2011’ – did completely depress and terrify me at the same time- I went for it and again it appears to have worked.
I say appears because I am nervous. It’s the same as when you become superstitious about telling your mother that your baby is sleeping through the night- you don’t want to jinx it. (Science just doesn’t match superstition).
(Another apparently useful (but expensive) treatment for PF is high energy extracorporeal shock wave therapy (HESWT). The results of the meta-analysis provide strong evidence that HESWT was effective in the treatment of recalcitrant plantar fasciitis when compared with placebo. We recommend HESWT as a remedial measure after failure of traditional conservative treatment and ahead of surgical intervention.)
So to Dr Steve – I tentatively say an enormous thank you again. The test will come when I head off on holidays very soon – walk the walk to the plane and traipse the streets of London and climb the trails of Mont Blanc.
And to all those out there who suffer with this very underrated affliction, I hope you gain something from reading the evidence and knowing that I feel your pain and have enormous sympathy for you- for something that reminds you every second step you take – of this awful pain.
I’m coming for you Mont Blanc!
L’Aiguille du Midi (3842m)
(I doubt I’ll be brave enough to do this though!)